Physiology, Counterstrain and Facilitated Positional Release (FPR)

Excerpt

Osteopathic manipulative techniques can be classified as direct or indirect. A direct technique requires positioning the patient against a barrier. In contrast, an indirect technique entails placing the patient in a position of ease. Strain-counterstrain (SCS), aka Counterstrain (CS), and Facilitated Positional Release (FPR) are two commonly used indirect oseomanipulative techniques. SCS is a soft tissue technique that passively treats musculoskeletal pain, impaired range of motion, and somatic dysfunction by influencing the cellular function of the tissues being treated.

Dr. Lawrence Jones developed SCS in 1955 when he encountered a particularly challenging back pain case at his clinic. The patient improved after remaining for some time in a position of ease where Dr. Jones put him. The same technique produced similar results in other patients. These encounters helped Dr. Jones discover "tenderpoints," or areas where pain is most pronounced in a muscle group. Tenderpoints have concomitant soft tissue textural changes at sites that would not usually cause pain. Proper management rests on identifying these areas.

SCS uses palpation and physician feedback to manipulate the soft tissues or joints into a position of ease, away from the restrictive barrier. Compressing or shortening the area of dysfunction relaxes the guarded muscles.

FPR is similar to SCS in that the physician places the patient in a position of comfort after identifying a sore area. However, an additional activating force is applied to relax the affected muscle faster. Stanley Schiowitz developed this technique in 1990.